“gift(s) of life” is ethically consistent with our current medical and
social environment.

Today, patients are already taking advantage of a thriving black
market in other countries to locate and pay a living person for his or her
precious kidney. Can we blame patients for desperately seeking to avoid
the fate of many of the waiting 70,000 people who will die before having a transplant? Neither
donors nor recipients in these covert situations receive care equivalent to that provided in
legitimate centers; poorer outcomes and increased risks for both have been documented.

The ethics are no different than in other established practices in our culture. Consider
payments for human semen or eggs for fertility procedures, or temporary use of an entire
body for clinical experimentation or pregnancy (e.g., surrogate mothers). Who would

“volunteer” without compensation?

We capitalists have already accepted that viewing one’s body as a commodity appeals
most to the financially needy. After all, financial enticements, such as college education, are
used to lure those who are disproportionately disadvantaged to military enlistment and to
accept the risk of death. Families are even granted a “death benefit” if that ultimate sacrifice
is made. How is donating a kidney to save a life different?

Denial of a tangible benefit to donors is hypocritical since every other involved party
enjoys measurable gains, including the recipient (who lives longer), the transplant surgeon
and other health-care providers (who are reimbursed), and even taxpayers (Medicare pays the
majority of dialysis costs).

To ensure equity and morality, a government agency with multidisciplinary expert guidance should develop medical criteria, select appropriate compensation (including lifelong
access to care for the donor), mediate between the parties and provide needed resources
(ultimately saving cost).

If this approach still feels unsavory, consider honestly whether your opinion would be
different if your own life depended on an unavailable organ. C

Amy L. Friedman, M.D., is an associate professor of surgery at
Yale University School of Medicine.

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from experts in the field:

WITH A CHRONIC shortage of available organs and patients dying
while they wait, why not allow a market for the sale of organs? There
are two compelling reasons to object to the sale of organs, whether
from living donors or the families of patients who have recently died.

The first one is exploitation; that is, when one person takes advantage of the misfortune
of another for his or her own benefit. There are many people in the world who live in settings with limited opportunities to improve their lives, and for whom $5,000 or $10,000
offers truly life-changing possibilities. But it is only because of existing social conditions
that selling a kidney for what seems to be an impossibly large sum becomes attractive.

Organ donation has always relied on the altruism of donors and their loved ones, with
the hope that whatever risk is involved is balanced by the benefit of the good deed of donation. But most people have a price that will encourage them to ignore whatever qualms they
have about donating an organ. And that changes the relationship from giving a gift to being
paid enough to ignore risk. A market allows this shift, and it is a change we have been and
should be loath to accept.

Second, the sale of organs gives an advantage to those with the means to pay for them.
Whatever problems exist in the current system of organ allocation in terms of shortages and
waiting times, it is at least fair. Rich patients can’t pay to jump to the front of the queue. But
that is exactly what would happen (and what does happen on the black market) in the case of
a market for organs: Those who can pay the most would get organs first. We may accept such a
free-market approach with other commodities—the newest car or the latest electronic gadget—
but it is much less defensible to allocate scarce lifesaving medical technology in the same way.

While the existing system of organ donation is far from perfect, it saves thousands of
lives every year. It is a system built on a fragile trust that took a long time to develop and
needs constant attention. It is a trust that cannot withstand the prospect of classified ads
and online auction sites for human organs, alongside antiques, art and sporting goods. C

Jeffrey Kahn, Ph.D., MPH, is director and Maas Family Endowed
Chair in Bioethics at the Center for Bioethics, University of
Minnesota (
www.bioethics.umn.edu). He is also a professor
at the university’s medical school.